heart conditions

Common tests during pregnancy include ultrasounds and blood sugar screenings. But heart tests – such as electrocardiograms (EKGs) – are also sometimes necessary.

Obstetricians discuss and evaluate their pregnant patients’ heart health to gain knowledge of a woman’s family history and risk factors. In cases of prior heart problems, we need to take special care to manage heart health during pregnancy.

As little as 15 years ago, a woman with a condition such as a congenital heart defect would have been advised to never get pregnant. We just didn’t think her heart could handle pregnancy, labor and delivery. But thanks to advances in medicine, growing expertise and doctors from multiple specialties – and facilities – working together, more and more of these women are able to safely give birth.

I’ve cared for a woman who had a heart valve replacement when she was 26. She became pregnant and delivered a healthy baby a year later. There’s no getting around it, such pre-existing conditions add complications to a pregnancy. But in many cases, the staff and resources are available to care for these high-risk patients and help them plan for safe, healthy pregnancies and deliveries.

The January 2017 guidelines issued by the American Heart Association agree, recommending that women with serious congenital heart defects work closely with their cardiologist and maternal-fetal medicine specialist before, during and after pregnancy. The guidelines also recommend giving birth at a larger medical center with specialists who have the necessary expertise to manage such a delivery.

Planning for pregnancy with a heart condition

Before you become pregnant, sit down for a discussion with a cardiologist and a maternal-fetal medicine specialist. It’s important that everyone is aware of your health history and the potential risks involved.

We’ll also want to evaluate:

Medications: Some medications can harm a baby during pregnancy, so we’ll want to discuss changing a medication or adjusting the dosage.

Potential procedures: Certain conditions should be fixed before pregnancy. This could include repairing a hole in your heart or opening a blocked valve.

Your family doctor or general obstetrician may not have the expertise to plan for or manage such a complex pregnancy. It takes a unique understanding to optimize the care and outcomes for these women.

We’ll help connect you with an experienced team through our Special Moms/Special Babies program, which offers coordinated care for moms with congenital health problems. We also partner with Children’s National Health System, with whom we share a campus, to care for pregnant women in their adult heart clinics.

There are still some circumstances in which we may advise you to not become pregnant. If this is the case, talk to your doctor about reliable birth control options.

Managing a heart condition during pregnancy

Every pregnancy causes the heart to work overtime. For example, the amount of blood it pumps can increase by as much as 50 percent to sustain a growing baby.

Physical changes during pregnancy affect which stressors the maternal heart faces. And when an underlying cardiac problem is in play, we become more worried about the potential for heart failure, heart attack and pulmonary hypertension, among other things.

Your care team likely will include a maternal-fetal medicine specialist, obstetrician, cardiologist, neonatologist and other specialists as needed.

And, of course, we’ll keep an eye on your baby. For example, we know that if mom has an arrhythmia, the baby can develop it as well, so we’ll monitor for that.

Going into labor and delivery

Your team will collaborate with you on a plan for labor and delivery based on your health. This will include deciding whether certain specialists need to be present, in which case we may plan to induce labor.

We’ll monitor your and your baby’s hearts throughout the process. Pushing can put additional stress on the heart, so we might limit how long you push, or give you additional assistance using forceps or a vacuum extractor. In some cases, a cesarean section may be necessary.

If you decide you would like to have another baby, talk with your cardiologist and maternal-fetal medicine specialist before you get pregnant again. Your heart health may have changed since your first pregnancy. And even if it hasn’t, every pregnancy is different. We want to prepare for all possibilities.

With proper planning and precautions, more and more women who thought they could never give birth due to a heart condition are realizing their dreams and taking home healthy babies.

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